Figure Muscle biopsy of the left biceps showing the characteristic pathologic findings in BCIM Muscle biopsy of the left biceps showing the characteristic.

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Figure Muscle biopsy of the left biceps showing the characteristic pathologic findings in BCIM Muscle biopsy of the left biceps showing the characteristic pathologic findings in BCIM (A.a, B) Cryostat sections stained with hematoxylin phloxine saffron show widespread muscle fiber atrophy without perifascicular distribution, endomysial fibrosis, and numerous necrotic and regenerating fibers. (A.b) Alkaline phosphatase staining of the perimysium. (C) Multiple inflammatory foci, with a perivascular and perimysial (D) and endomysial distribution (E). Germinal centers with polarization were occasionally seen (F), which stained for CD10 and bcl-6, but not bcl-2, ruling out follicular lymphoma (not shown). Immunohistochemistry showed that inflammatory infiltrates were composed of CD20+ B cells (G) along with CD4+ and CD8+ T cells (not shown). Multiple CD20+ B-cell foci were appreciated (H). Membrane attack complex (MAC) deposition was widespread in the endomysium, with several examples of MAC deposition around multiple fibers, confirming its endomysial location (I, green arrows). Andrew F. Gao et al. Neurol Neuroimmunol Neuroinflamm 2018;5:e410 Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.